Gout Treatments

Preventing gout attacks with medications and lifestyle changes

The treatment for gout is designed to help alleviate pain from the start, typically within a few hours. Once medication is started symptoms will begin to subside and should be gone within 5 to 8 days.  The next important step following treatment is working on a prevention plan to keep the pain from ever coming back.

Treatments for Acute Gout Attacks

In most cases, your primary care provider will begin treatment for gout by addressing pain. A non-steroidal anti-inflammatory drug (NSAID) like naproxen, indomethacin, or celecoxib may be prescribed to lessen inflammation and relieve any associated pain and swelling.  Corticosteroids are also an option for inflammation and pain. These can be administered via a pill or an injection directly to the affected joint.

Another option for pain control is colchicine. This medication is associated with side effects like nausea, vomiting, and diarrhea if taken in large doses, so doctors tend to prescribe it in lower daily doses to prevent future attacks.

Preventing gout attacks involves maintaining low uric acid levels with lifestyle treatments and medications. (Source: 123RF)

If you live with other types of arthritis in addition to gout, your primary care provider may refer you to a rheumatologist, a physician who specializes in treating arthritis and other joint conditions.

If you see specialists for other health conditions, make sure they are aware of your gout and the details of your treatment plan, since there are known interactions and contraindications with some medicines.

Once the pain is under control, the next step in treatment is to prevent gout from coming back.

Prevention: Medication and Lifestyle Changes 

Gout is one of the most manageable types of arthritis. With a few lifestyle changes, you can prevent gout from flaring up by keeping uric acid down at normal levels. With persistence and a little bit of discipline, you can prevent new uric acid crystals from forming, which will keep gout attacks at bay.

Around 80% of people with gout can attribute the buildup of uric acid to under-performing kidneys. If kidneys don’t filter out enough uric acid, crystals form and gout begins its attack. Urate-lowering medications such as xanthine-oxidase inhibitors include allopurinol and febuxostat (Uloric); they are first-line treatments for chronic gout.  To combat a low-performing set of kidneys, doctor turn to medications called uricosurics such as probenecid or lesinurad (Zurampic). This class of medication helps kidneys expel uric acid more efficiently, but they should not be used if there is chronic kidney disease since there is a higher risk of forming kidney stones. There is a combination pill, lesinurad and allopurinol, that has recently been made available to treat chronic gout.  A uricase, such as pegloticase (Krystexxa) or rasburicase, is reserved for tophaceous gout that does not respond to standard treatments for gout.

While some gout prevention plans may include medication to lower uric acid levels in your blood, one of the best plans of attack to prevent gout from resurfacing and reduce the risk of flare-ups include making changes to your lifestyle and diet. These changes may include:

  • reducing the amount of organ and glandular meat, like liver and sweetbreads. These meats have high purine levels which can contribute to higher levels of uric acid in the blood
  • keeping red meat and seafood (like anchovies, shellfish, and tuna) consumption down to 4 to 6 ounces per day
  • limiting your intake of sugary foods and fruits, soda as well as fruit juices high in sugar
  • eliminating alcoholic beverages, such as beer and liquor
  • working toward a healthier weight by exercising regularly and talking to your doctor about developing a nutrition plan to help you reach your goals.

Combining these two methods, medication and lifestyle changes, can help most people keep their uric acid levels under control and their gout attacks at bay.

Updated on: 02/12/19
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